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Objective To study the application effects of timely regional vascular occlusion in primary liver cancer(PLC) surgery. Methods Eighty-eight patients with PLC who underwent surgery in the Department of General Surgery of Yan'an University Affiliated Hospital from January 2014 to December 2016 were selected for prospective study, and they were divided into the experimental group and the control group by the random number table method, 44 cases of each group. In the experimental group, the blood supply was blocked with timely regional vascular occlusion while in the control group, the blood supply was blocked with half hepatic vascular occlusion. The occurrence of postoperative complications, and surgical indexes(surgical time, intraoperative blood loss, the time of hepatic portal occlusion, blood transfusion volume, abdominal drainage volume and hospital stay), levels of alanine aminotransferase, albumin and total bilirubin, levels of CD3+, CD4+, CD8+ and CD4 + /CD8 +, effective rate, control rate, and clinical efficacy were compared between the two groups. Measurement data with normal distribution were represented as (x) ± s and analyzed using the independent-sample t test between the two groups; within the groups, paired t-tests were used. Comparison of count data were represented as n(％ ), and analyzed using the chi-square test. Results The intraoperative blood loss, time of hepatic portal occlusion, blood transfusion volume and hospital stay of the experimental group were(331. 48 ±30.65) ml, (14.78土2.27) min, (132.61 ±13.87) ml, (9.29土1.19) d, and the control group were (500.61 ±50.62) ml, (23.96±2.89) min, (305.76 ± 30.64) ml, (12.10 ± 1.22) d, with statistically significant differences in above indexes between the two groups(all P< 0.05). The operation time and abdominal drainage volume in the experimental group were(146.86 ± 15.87) min and(321.77 ±33.65) ml respectively, while those in the control group were (143.07土15.35) min and(335.18 ±33.82) ml respectively, there was no significant difference between the two groups(P> 0.05 ). After surgery, the levels of alanine aminotransferase, total bilirubin and albumin of the experimental group were(54.86 ±5.61) U/L, (20.65 ± 2.32) U/L, (41.95土4.32) ng/ml, and the control group were(120.75 ± 13.03) U/L, (35.42+3.21) U/L, (70.25 ±7.45) ng/ml, with statistically significant differences in above indexes between the two groups(all P <0.05). After surg;ery, the levels of CD3 +, CD4+, CD8 + and CD4 + /CD8 + of the experimental group were 0.63 ±0.16, 0.52 ± 0.11, 0.20 ±0.04, 1.70 ±0.17 and the control group were 0.56 ±0.14, 0.45±0.12, 0.26 ± 0.05, 1.46土0.22, with statistically significant differences in above indexes between the two groups (all P< 0.05 ). There were no differences between the experimental group and the controlg roup in the response rate and the control rate(75.00％ vs.79.55％; 88. 64％ vs.90.91％ ) (P>0.05). Conclusions The application of timely regional vascular occlusion in PLC surgery can reduce the intraoperative blood loss, the time of hepatic portal occlusion, blood transfusion volume and hospital stay, improve the immune level and liver function. And there is no difference in response rate and control rate compared with half hepatic vascular occlusion, therefore it is worthy of clinical application.
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Objective To investigate the prognosis effect of different methods for blocking hepatic blood volume in patients with liver cancer .Methods The clinical data of 105 cases with different methods (whole liver hepatic pedide block concluded 38 cases , semi-block 32 cases ,regiosnal block 35 cases) for blocking hepatic blood volume with liver cancer were analyzed .Results The bloc-king blood loss ,intraoperative blood transfusion ,liver blood blocking and hospitalization time of regional block group were less than those of the whole liver hepatic pedicle block group and semi-block group(P 0 .05) ,but the rate of rea blocked complete remission was significantly higher than that of the other two groups(P<0 .05) .Conclusion The application of regional blood flow in patients with primary liver cancer timely blocking technology can minimize liver tissue hypoxia and ischemia time ,effectively control the liver bleeding cut .
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Objective To summarize the experience of performing a variety of hepatectomies by occluding the branches of the hepatic artery (HA) and portal vein (PV) to the liver lobe, segment or subsegments in hilar H fissure for 344 patients in this hospital from 1987 to 2008. Methods (1) According to the size and location of the liver focus, major hepatectomy (66 cases), resection of separated hepatic subsegments (15 cases HS), resection of adjacent HS (216 cases) and resection of single HS (46 cases) were performed. (2) For left lateral HS, the left lateral inferior PV and left lateral superior PV originating from the lateral aspect of the left PV (LPV) were dissected, isolated and severed in umbilical fissure after the LHA was occluded. (3) For left medial HS, the left medial inferior PV and left medial superior PV originating from the medial aspect of the left PV were dissected、isolated and severed in umbilical fissure after the middle HA was occluded. (4) For right anterior HS, the right anterior PV was isolated and occluded in the anteior sulcus of the right longitudinal fissure (RLF) after the RHA behind the main hepatic duct was occluded. (5) For right posterior HS, the right posterior PV was isolated and occluded in the posterior sulcus of RLF after RHA was occluded.(6)The corresponding hepatic venous stem was protected as much as possible during the operation.Results (1) The operative mortality was 2.9% (10/344). Of these 10 patients, 8 died of liver failure and 2 bleeding. (2) Ten HCC patients (n=200) survived for 11～20 years, 4 for 7years, 19 for 5years and the 5-year survival rate was 18. 3% (33/180). For patients with hilar cholangiocarcinoma (n= 14), only 3 survived for 13, 6, 4 years, respectively. The patients with intrahepatic cholangiocarcinoma (n=13) survived for 1/2～3 years. Those with carcinoma of the gallbladder (n=12) survived for 1/2～1 year. All the patients with benign liver diseases (n=92) were cured. In 7 patients with intrahepatic lithiasis, the stones in other locations needed to be managed. Conclusion (1) Separated multiple hepatic subsegmentectctomy is an effective procedure to cure the compacted stones in 2～6 subsegmental hepatic ducts in both right and left lobes. (2) This procedure is reasonable, effective and of low cost for hepatectomy, worthy of being used because of the decrease in the ischemic liver mass and blood loss in operation, increase in the resectability of bulk liver cancer, alleviation of postoperative liver dysfunction and meeting the technical needs of a variety of hepatectomies for various liver diseases fulfilled by regional vascular occlusion at hepatic hilum instead of total hepatic afferent blood flow occlusion.
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Objective To study the experience on a variety of hepatectomy by occluding the branches of hepatic artery and portal vein to the liver lobe,segment at hilar H fissure.Methods A total of three hun-dred and ninteen patients accepted hepatectomy in Hunan provincial people's hospital from Decemember 2006 to Decemember 2007 were involved in this study for retrospective analysis.Results There were no perioperative deaths and liver function failure in this series of patients.The average amount of blood loss was 70 15ml,and 302 (95 %)cases did not receive transfusion.Postoperative complications such as liver necro-sis,bile leaking,bleeding were not found.Subphrenic abscesses were found in 3 cases,which were cured conservatively.Conclusion Selective regional occlusion of hepatic blood flow during bepatectomy avoided the risk of ischemia-reflow injury of remnant liver,which is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.